Top Lessons from 50 Years of Fighting the Tobacco Industry

This month’s 50th anniversary of the First Surgeon General’s Report on Smoking and Health provides a bittersweet reminder of the promise and the limitations of public health activism to curb corporate promotion of behaviors and lifestyles associated with premature death and preventable illness and injury. In the half century since the report was released, the proportion of Americans who smoke has been cut in half. A new report in the Journal of the American Medical Association estimates that tobacco control efforts in the United States have prevented 8 million premature deaths and extended the average lifespan by on average almost 20 years of life for the people who did not take up smoking because of prevention campaigns, higher tobacco taxes or smoking bans. Overall, the success in reducing tobacco use has added 2.3 years to the life of the average American man and 1.6 years to the average American woman.

But this progress could have been achieved in far less time had not every preventive policy been opposed by the tobacco industry and had politicians beholden to the tobacco lobby severed these ties more quickly. These delays doomed many more to tobacco-related illnesses. And despite the progress in this country, the estimated toll from tobacco in this century is 1 billion premature deaths, more than 10 times the toll for the 20th century. The main reason so many more people will fall ill and die painful, early tobacco-related deaths is that the tobacco industry has adapted the lessons on marketing and undermining regulation that it learned in the United States to emerging markets in Asia, Africa and Latin America.

Sadly, the tobacco industry is not alone in contributing to America’s poor health standing among developed nations. In 2010, guns took the lives of 31,076 Americans in homicides, suicides and unintentional shootings, the equivalent of more than 85 deaths each day. Another 73,505 Americans were treated in hospital emergency departments for non-fatal gunshot wounds. While the scientific knowledge and technology to significantly reduce this toll are available, like the tobacco industry, the gun industry and its allies in the National Rifle Association have steadfastly blocked any progress to make guns less accessible or safer.

Similarly, the alcohol industry contributes to alcohol related injuries and illnesses by aggressive marketing, expanding the density of alcohol outlets, and designing products such as wine coolers and malt liquors to appeal to young drinkers. A recent study found that between 2001 and 2009, youth exposure to television alcohol advertising increased by 71%. Excess alcohol consumption accounts for about 4,700 annual deaths among underage drinkers. Another study estimated that the combined market value for the alcohol industry of illegal underage drinking and adult problem drinking accounted for between 37.5 and 48.8% of consumer expenditures for alcohol.

How has it come to pass that corporations now have a stronger influence on the health of Americans than public health officials, doctors or hospitals? How have corporations succeeded in convincing so many officials in the White House, Congress and the supreme court that protecting profits is a higher national priority than protecting public health?

In the last decades, a corporate consumption complex has solidified its influence on American politics and the economy. This web of consumer corporations, the bankers and hedge funds that lend them money, the trade associations that lobby for them, and the global ad agencies that market their products has been able to use its campaign contributions, lobbying and lawsuits to achieve its business goals even when the majority of Americans disagree with these. Like the military industrial complex that Dwight Eisenhower warned about before he left public office, the corporate consumption complex threatens our democracy as well as our health and environment.

Are there lessons from our partial successes in cutting tobacco use that could be applied to reducing the power of the corporate consumption complex and its brand of hyperconsumption? I suggest three.

1. Efforts to reduce tobacco use succeeded when Americans came to believe that the right to breathe clean air trumped the tobacco’s industry’s right to promote its products without public oversight. Today, we need to mobilize parents to demand our children’s right not to be shot and not to be targeted by marketing of fast food, sugary beverages and snacks that have contributed to a 176% increase in the prevalence of diabetes between 1980 and 2011.

2. Part of the success in reducing smoking came from forcing Big Tobacco to reimburse state governments for the costs of caring for people with tobacco-related illnesses. Enacting policies that would require processed food producers to reimburse taxpayers and victims of the diet-related diseases exacerbated by their promotion of high fat, sugar and salt diets and alcohol producers for those injured or killed by the binge drinking.

3. Fund independent hard-hitting prevention campaigns designed to undo the deceptive advertising Big Tobacco had sponsored. We can do the same thing by counterbalancing the media and ad campaigns today targeting young people to eat bad foods and glamorize guns.

In 1964, most observers thought it was politically impossible to defeat the tobacco industry and to bring about significant reductions in tobacco use. Today, changing the practices of the firearms, alcohol and processed food industries seems a similarly daunting task. But if we can apply the lessons from tobacco to accelerate changes in harmful business practices, perhaps we won’t need to wait another 50 years to prevent the deaths, illnesses, injuries and rising healthcare costs that today’s science could avert.

Post script: 219 Guardian readers commented on this column in the week since it was posted. A review of these comments provides a good overview of public debates about individual and corporate responsibility –as well as the occasional nuttiness of online commentary.

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